Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.     

Spontaneous Moments and the Domain of Non-Verbal Communication

Abstract

This paper investigates the impact of non-verbal interactions and spontaneous encounters on the therapeutic process and on a client's structural and behavioral patterns. The following case vignette concerns a client who presents with a pattern of non-verbal relational schemas based on his early traumatic experiences. The non-verbal and verbal role reenactments that unfold between client and therapist will be examined from an intersubjective, dialogical and self psychological perspective. Finally, the paper will explore how important therapeutic shifts may occur by attending to and working through these non-verbal aspects of the treatment, leading to new relational structures.     

Therapeutic Alliance,Interpersonal Relations,and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories

The current study explored the dimensions of the early therapeutic alliance (tasks, goals, bonds, and other-therapist [people important to clients who support their involvement in therapy]) as mediators between clients’ interpersonal relations problems and outcome measures of trauma symptoms (dissociation and total trauma symptoms). Seventy-six female participants who were receiving treatment for posttraumatic stress due to child abuse (CA), were recruited from a university training clinic. The bond and other subscales mediated the association between interpersonal relations problems and dissociation. The element of client trust associated with the alliance bond, as well as clients’ sense that people who are important to them support their involvement in therapy, should be focal in treating CA survivors. Clinical implications revolve around developing, maintaining, and repairing the therapeutic relationship, especially the bond, within the context of dissociation, as well as exploring clients’ views of important others and its impact on their therapy.     

Walking in sacred spaces in the therapeutic bond: therapists' experiences of compassion satisfaction coupled with the potential for vicarious traumatization

The therapeutic bond is at the heart of effective therapy, yet few studies have examined therapists' experience of this bond. Using a qualitative study design, this exploratory study examines the experiences of couple and family therapists in relation to their perceptions of the satisfactions and risks involved in the therapeutic bond. The research was conducted using grounded theory methodology and eight in-depth interviews were conducted with therapists working in five counseling agencies in Sydney, Australia. Therapists described the importance of the 3 component parts of the therapeutic bond: the empathic connection between therapist and client; the role investment of the client; and the mutual affirmation experienced by both therapist and client in the therapeutic process. Walking in sacred spaces with the client was seen as both enriching and challenging for the therapist. The therapeutic bond gave therapists intense satisfaction and posed risks for them, especially when working with traumatic client experiences. However, the findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization. The implications for sustaining couple and family therapists in their work are discussed.     

Therapeutic moments are the key: foster children give clues to their past experience of infant trauma and neglect

Foster parents often despair over the lack of information about the past experience of the children in their care, particularly with children who have experienced infant trauma and neglect. In the context of family therapy these unknowns pose both a challenge and an opportunity. The author proposes that foster children gives clues to their past experiences in therapeutic moments, which the therapist may recognize as a result of her own inner conversation. In conjunction with a sound theoretical knowledge of infant trauma and neglect, these moments have the capacity to open a dialogue in the relationships between therapist, child and foster family. This dialogical process offers an opportunity for the child's past experience of infant trauma and neglect to be expressed in silence, and the foster parent's present experience to be heard in stillness, opening for them a way to go on beyond the family therapy sessions.     

Using Creative Techniques With Children Who Have Experienced Trauma

Verbal and emotional forms of expression can be difficult for young children who have experienced trauma. Creative methods and approaches such as puppets, sandtray, letter writing, and art are therapeutic mediums that provide an outlet for a young client’s story of trauma to be told. Children can use puppets to depersonalize and share feelings with a counselor that would provide insight into their coping strategies. Similarly, sandtray is another nonverbal approach that gives children the opportunity to externalize their feelings safely and can be easily used with extroverted and introverted clients. Letter writing and art can empower children and give them hope for the future. In summary, creative techniques can allow counselors to help explore stories of trauma with young clients.     

Reply to Panel Follow-up Questions

When both therapist and client share a traumatic event, there are multiple levels of vulnerability to traumatization for the therapist. Our personal vulnerability is not only a backdrop for our clinical work but also an acknowledged fact in many therapeutic relationships, a situation that changes the frame of the work. In addition to clinical challenges, shared trauma increases a therapist's vulnerability to vicarious traumatization; VT is defined as the negative transformation of the therapist's inner experience as a result of his or her empathic engagement with and responsibility for a traumatized client. Emphasizing the importance of awareness, self-care, meaning, and community, the article summarizes important steps to anticipate, address, and transform the therapist's experience of vicarious traumatization.     

Surviving Deadness in the Analytic Experience

The transference/countertransference (third space) analysis is considered to be central in the therapeutic effectiveness of the analytic process. Less emphasis has been placed on the actual experiences of analyst and analysand in the conflictual reenactment of third space experience and its resolution. This paper recounts the shared experience of a patient who was silent throughout most of the analysis, and my reaction, in fantasy and enactment, to this disturbing experience—both for him and for myself. I argue that it is the affective re-experiencing of past repressed trauma in the analytic space that has a therapeutic impact, leading to growth in the patient and also the therapist. I contrast Freud’s emphasis on insight, making the unconscious conscious, with Ferenczi’s suggestion that the therapeutic impact lies in the repetition of past traumatic experience in the analysis but with the possibility of a different outcome with a more benign object, leading to symbolic representation of repressed trauma. Re-experiencing and symbolization, in the third space, of past traumatic experience can be an exit point from the endless repetition of trauma in internal and external object relations, leading to a new beginning in the patient’s life. Immersed in the experience of deadness in the analysis, which had become a dead womb, the struggle to remain alive and thinking led to a rupture out of the dead womb, like the Caesura of birth, into aliveness and the ability to mentalize what had previously remained unmentalized.     

Languages of trauma; towards a phenomenological response

In this article, I explore the possibilities of a phenomenological perspective on trauma in psychoanalytic practice. I highlight the problem of interpretations that universalise experiences of trauma, provide explanations in terms of ‘causes’ and assume particular processes/stages of ‘recovery’ from it. The notion of trauma challenges dichotomies of ‘internal’ and ‘external’ worlds. Traumatic experiences always have a context – that of the immediate relational circumstances of the individual suffering from the trauma, including the wider social/relational context, and the person’s history. I argue for an attunement to the language and specificity of the meanings, verbal and non-verbal, conscious and unconscious, of the client’s suffering within the analytical relationship. This requires the therapist to avoid ‘ready-made’ interpretations from psychoanalytic theory and to be open to the poiesis of the speech, which emerges between therapist and client. My discussion of my reading of the Chilean documentary film, Nostalgia for the Light, which focuses on the traumatic experiences of those who survived Pinochet’s military regime (1973–1989), highlights how diverse responses to trauma are. The originality of the language of the film calls on us as therapists to discover new ways of listening and speaking to our clients’ suffering.     

Therapist memory and reverie: implications for the clinical setting

In this work, the author considers reveries to be ‘dream-like-memories’. In the course of a session they appear as proto-memory – the therapist’s early traumatic object relations that are recorded in the unconscious at an almost bodily level (a type of unthought known) and which are resurrected between therapist and patient when a similar traumatic subject arises between them. The therapist’s reveries are recollections in the form of dream-like allusions to his past experience. A clinical vignette from the psychotherapy of a child whose father suffered from PTSD (following a wartime experience in Afghanistan and Iraq) is discussed. Dissociative dynamics were repeated in the therapeutic relationship, in the form of an obsessive game intending to preserve the state in which there was no need to remember what had been unconsciously transmitted to the child: his father’s wartime experience. The projection of the primary elements which had been silenced evoked in the therapist allusions to his unconscious identification with his ancestor’s post-traumatic experiences. These allusions helped in overcoming the dissociated state. The role of memory in child psychotherapists’ receptivity of trauma is revisited.     

Broken mirror: The intertwining of therapist and client stories of childhood sexual abuse (CSA)

In recent years, there has been a great deal of attention given to the potential increased risk of vicarious traumatisation (VT) for clinicians with a history of childhood sexual abuse.

I am curious about whether the silencing, which has been ubiquitous within society, is also prevalent within the therapeutic profession. I wonder if therapists with a history of abuse feel they have to bracket their experience, and if this limits the potential for positive transformation.

In this paper, I draw upon my narrative study of therapists with a history of abuse. The methodology followed was narrative inquiry with two therapists in addition to an autoethnography. I used ‘narrative analysis’ to analyse the data. The findings of the study covered themes of transgenerational trauma, ‘the wounded healer’, caregivers’ responsibility in communal cultures and dissociation.

In this paper, I will consider the part dissociation plays when there is a shared history of trauma, and the ways in which dissociative enactments within the consulting room themselves may be part of the mutual healing. For this paper, only extracts from interviews with one of my participants will be included.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

The pregnant therapist and the psychotic client: A phenomenological understanding of the impact of the therapist’s pregnancy on the therapeutic process

This original paper examines the underresearched area of therapist pregnancy. It explores the impact of psychosis as an additional complicating factor to the therapeutic process and the experience of one British counselling psychologist working in the National Health Service whilst pregnant. Five brief client summaries/clinical examples are presented to explore the common themes of anger, rejection, abandonment and envy that often emerge following the disclosure of a therapist’s pregnancy or the opposite reactions of over-protectiveness and an unwillingness to engage in therapy for fear of harming the therapist. Recommendations are made for further research within this neglected area and the need to incorporate the themes within training for therapists and training for supervisors.     

Dissociation,the true self and the notion of the frozen baby

Abstract

The widespread ‘trauma talk’ that is prevalent in the social sciences, has, in recent years, become increasingly commonplace in psychoanalytic writings, especially in attachment theory and relational psychoanalysis. This paper examines dissociation, a key concept in ‘trauma theory’, in conjunction with the Winnicottian term ‘true self’, in the context of a particular discursive and theoretical combination of the two. This discursive formation is named ‘the frozen baby discourse’, and it is presented and analysed. A critique is offered of the way ‘true self’, understood as a humanistic concept, is often used together with dissociation, in order to create a theoretical construct that is far removed from Winnicottian theory. This paper begins by exploring definitional issues, both around dissociation and ‘true self’. It is subsequently argued that this contemporary usage of ‘true self’ in combination with dissociation has important implications for psychoanalytic practice.     

The client,the therapist and the paranormal: a response to the special edition on psychotherapy and the paranormal

Abstract

In this paper, I provide a published paper response to the papers in this special edition on the paranormal and psychotherapy articulated largely from my career as a parapsychologist. In the introduction I note the definitional differences between advocates and counter-advocates in terms of what might be ‘paranormal’, although I argue ultimately that definitional differences aside, the therapist’s relationship with the client’s unusual experiences is critical, taking a phenomenological stance which is echoed by at least two of the papers in the special edition. In broad review, the papers make a variety of welcome contributions; historical individually and small sample phenomenological and also more metaphorically in terms of articulations of the haunting nature of collective and intergenerational trauma in the social and cultural sphere. I review the papers from a parapsychological perspective, considering the evidence drawn from parapsychological studies where it supports or adds to the topics of each paper. In concluding this response, it seems clear that therapists often work from first principles when relating to clients’ anomalous experiences, and that the papers of the special edition each offer practising therapists some important evidential and practical insights into working with client presentations of ostensibly paranormal and anomalous experiences.     

Therapeutic Relationship

This article addresses the important role of the therapeutic relationship in cognitive-behavioral therapy (CBT). As has been noted from the inception of CBT, there are critical features of both the therapist and the relationship that optimize the likelihood of therapeutic success, and this article briefly describes these features. It is further argued that a successful therapeutic relationship in CBT is not static but is flexible and adaptive both across and within clients, as their needs and concerns vary. A positive therapeutic relationship is viewed within CBT as a necessary but insufficient condition for change, as the relationship serves as a foundation upon which interventions are scaffolded, but that the client’s response to various interventions itself shapes the interactions between therapist and client. Finally, it is argued that the key therapeutic ingredients of CBT are largely teachable, and the article provides several suggestions to promote an effective therapeutic relationship in CBT.     

Finding God in the Silence: Contemplative Prayer and Therapy

In this paper the author shares some of his experiences of using silence in therapy. He presents one of the modes of practicing silence, namely the meditation technique known as Contemplative Prayer, and shows advantages of using this technique in the process of self-purification and self-balancing of the therapist. The author stipulates that silence is a royal way to discovering God. Finding this divine particle within oneself and client changes the whole outlook of therapy. The therapist is no longer alone with the client, but God becomes an active participant in the therapeutic process through His love for both therapist and client.     

Intertraumatic Dissociative Attachment

SUMMARY

This article focuses on the treatment of couples with a collective personal history of multiple traumatic experiences, and central related concepts. Referred to as the intertrauma couples therapy (InTCT) model, this article outlines an approach to treating trauma victim couples in which each partner has suffered one or more traumatic experiences (i.e., war, rape, criminal assault, incest, community violence, etc.). InTCT is a structured five-phase model of care, derived from a long trauma treatment tradition, and the author's clinical experience in the treatment of multitrauma persons for over 20 years.

This comprehensive, integrative approach to treatment is designed to resolve chronic interpersonal hostility, isolation in marriage, fears of intimacy and engulfment, and the persistent revivifications of partners' traumatic memories as a painful product of daily relational encounters. Unfortunately, these encounters represent trauma structures interacting with trauma structures, with no end or relief to the mutual pain-generating interactional patterns. The phases of the treatment takes the couple from disorganization and intense emotional reactivity to stabilization through integration to an end phase with a post-integration life skills building program for lasting results. Also presented are issues such as attachment, specific trauma responses to include interactive concepts of trauma bonding and systems theory in the context of trauma and dissociation. The article also presents a multitrauma couple case study, and discusses the critical role of therapist's functions.     

Therapeutic Work with Trauma,Revictimization, and Perpetration: Bearing Witness,Offering Hope,Embracing Despair

ABSTRACT

This paper offers a case study of a survivor of childhood incest who in adulthood has become a victim of violence in her relationships with chosen partners and is concerned that she herself may be a perpetrator of sexual abuse. It examines selected literature on attachment, dissociation, transference/countertransference, role responsiveness and sadomasochistic therapeutic enactments, the two-system superego model, and the triadic self. The paper focuses on long-term treatment dynamics with survivors of cumulative trauma and explores such psychodynamic psychotherapy issues as the therapist as a perpetrator of violence, the development of sacred space, authenticity, and the importance of both offering hope and embracing despair in this work.